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Understanding safety-netting in remote consulting

02 January 2021
11 min read
Volume 32 · Issue 1

Abstract

The COVID-19 pandemic has changed the way health care is delivered. Paul Silverston explains the importance of providing appropriate safety-netting advice in remote consultations

In primary care, the COVID-19 pandemic caused a rapid switch from face-to-face to remote consulting, which presented few opportunities for nurses who were unfamiliar with remote consulting to undergo any training in this skill. The clinical assessment and clinical decision-making skills required in remote consulting are different from those in face-to-face consulting and there is also a higher risk of diagnostic and decision-making errors in remote consulting than in face-to-face consulting. Safety-netting is an essential part of safe practice in primary care to reduce the risk of serious harm to patients from these errors. This article discusses the principles and practices of safety-netting in remote consulting.

Over the past decade, there has been an increase in the number of practices offering remote consultations to patients. However, prior to the arrival of the COVID-19 pandemic, the vast majority of consultations conducted in primary care were face-to-face. The pandemic forced practices to switch to remote consulting in order to reduce the risk of viral transmission within the surgery and to enable the remote screening and assessment of patients with COVID-19 symptoms to occur. The speed at which this move from face-to-face to remote consulting took place, and the lack of a transition period during which training in remote consultation skills could occur, meant that many clinicians were thrust into remote consulting with little or no upskilling in telephone or video consulting. Clinical assessment teaching in postgraduate nurse education programmes focuses mainly on training nurses to perform face-to-face consultations and there is little or no training in the clinical assessment and clinical decision-making skills required for telephone or video consultations. The communication, clinical assessment and clinical decision-making skills differ between face-to-face and remote consultations and many clinicians who are very adept at conducting face-to-face consultations find remote consulting challenging and stressful because of the lack of training (Pygall, 2017).

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